Therapy And Severs Disease

21. May 2015

Overview

Sever?s disease, also known as calcaneal apophysitis or Osgood-Schlatter syndrome of the foot. This traction apophysitis is secondary to repetitive microtraumata or overuse of the heel in young
athletes. The calcaneus is situated at the most plantar posterior aspect of the foot. The Achilles tendon inserts to the lower, posterior and slightly medial aspect of the calcaneus. The plantar
fascia originates from the medial tubercle on the plantar aspect of the calcaneus. Proximal to the epiphysis is the apophysis, where the Achilles tendon actually inserts. The calcaneal growth plate
and apophysis are situated in an area subject to high stress from the plantar and Achilles tendon.

Causes

Your child may have pain along the edges of one or both heels during exercise. The pain usually goes away with rest, but may be worse in the morning. Your child's heel may also be slightly swollen
and warm. The heel pain may be worse when your child climbs steps or stands on tiptoe. It may cause your child to limp.

Symptoms

Sever's Disease is most commonly seen in physically active girls and boys from ages 10 to 15 years old. These are the years when the growth plate is still ""open,"" and has not fused into mature
bone. Also, these are the years when the growth plate is most vulnerable to overuse injuries, which are usually caused by sports activities. The most common symptoms of this disease include. Heel
pain in one or both heels. Usually seen in physically active children, especially at the beginning of a new sports season. The pain is usually experienced at the back of the heel, and includes the
following areas. The back of the heel (that area which rubs against the back of the shoe). The sides of the heel. Actually, this is one of the diagnostic tests for Sever's Disease, squeezing the rear
portion of the heel from both sides at the same time will produce pain. It is known as the Squeeze Test.

Diagnosis

Sever disease is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians, but if a diagnosis of calcaneal apophysitis is made without obtaining
radiographs, a lesion requiring more aggressive treatment could be missed. Foot radiographs are usually normal and the radiologic identification of calcaneal apophysitis without the absence of
clinical information was not reliable.

Non Surgical Treatment

* Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.

* Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.

* Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).

* Anti-inflammatory creams: Also an effective management tool.

* Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.

* Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.

* Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.

* Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.

Exercise

For children with Sever's disease, it is important to habitually perform exercises to stretch the hamstrings, calf muscles, and the tendons on the back of the leg. Stretching should be performed 2-3
times a day. Each stretch should be performed for 20 seconds, and both legs should be stretched, even if the pain is only in one heel. Heel cups or an inner shoe heel lifts are often recommended for
patient suffering from Sever's disease. Wearing running shoes with built in heel cups can also decrease the symptoms because they can help soften the impact on the heel when walking, running, or
standing.